Nailfold capillaroscopy: relevance to the practice of rheumatology

Souza, Eduardo José do Rosário e; Kayser, Cristiane

doi:10.1016/j.rbre.2014.09.005

Cited by 18 publications

(19 citation statements)

References 47 publications

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“…Nailfold capillary videomicroscopy allows convenient in vivo visualization of the microvasculature at the junction of the fingernail and skin. Nailfold capillary videomicroscopy is used for diagnostic purposes in rheumatology 19 and has served a role in defining vascular changes in primary open-angle glaucoma (POAG). [20][21][22] Although nailfold capillary hemodynamics in XFS have been assessed, 16 the nailfold capillary morphology in XFS/XFG has never been studied.…”

Section: Introductionmentioning

confidence: 99%

Nailfold capillary morphology in exfoliation syndrome

Cousins

Kang

Bovee

et al. 2017

Eye

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Purpose The purpose of the study was to investigate nailfold microvascular morphology in exfoliation syndrome with or without glaucoma (XFS/XFG) compared with primary open-angle glaucoma (POAG) and control subjects using nailfold capillary videomicroscopy. Patients and methods We used a JH-1004 capillaroscope to perform nailfold capillary videomicroscopy on the fourth and fifth digit of the non-dominant hand. We enrolled 56 XFS/XFG patients, 87 POAG patients, and 75 control subjects. Masked observers graded the videos for hemorrhages, avascular zones ≥ 200 microns (μm), and degree of microvascular tortuosity on a four-point subjective scale. Multivariable odds ratios, 95% confidence intervals and P-for trends for assessing the relation between morphological changes and POAG or XFS/XFG were obtained from logistic regression analyses. We also assessed this relation with XFS/XFG compared with POAG in multivariable models. Results After adjusting for multiple covariates, nailfold hemorrhages, avascular zones ≥ 200 μm, and higher degree of vascular tortuosity were more common in XFS/XFG vs controls (P-for trend ≤ 0.0001) and in POAG vs controls (P-for trend ≤ 0.01). For each 100 capillaries, the number of hemorrhages was similar (P-for trend = 0.91) between XFS/XFG and POAG patients; however, there were more avascular zones per 100 capillaries with borderline significance (P-for trend = 0.04) in the XFS/XFG group. XFS/XFG patients had more tortuosity than POAG patients; specifically, having a tortuosity score ≥ 1.5 was associated with a 4.4-fold increased odds of XFS/XFG (95% confidence interval: 1.5-13.3) relative to a tortuosity score o1.0 (P-for trend = 0.005). Conclusion A high degree of nailfold capillary tortuosity is a distinct non-ocular feature associated with XFS/XFG compared with either POAG or controls.

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Section: Introductionmentioning

confidence: 99%

Nailfold capillary morphology in exfoliation syndrome

Cousins

Kang

Bovee

et al. 2017

Eye

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“…Capillaroscopy provides quite accurate assessment of blood vessels condition. On the basis of this finding, it is possible to differentiate primary from secondary Raynaud's phenomenon (RP), to detect a disease before other clinical manifestations, predict the development of the disease, to assess the disease activity and early detect involvement of the internal organs in SSc 7,21 .…”

Section: Discussionmentioning

confidence: 99%

“…In about 90% of all patients with SSc, RP is the first symptom of the disease. The characteristic of the secondary RP is pathological capillaroscopy pattern, also referred to as scleroderma pattern 21,24 .…”

Section: Discussionmentioning

confidence: 99%

The impact of altered hands function on working ability of patients with systemic sclerosis

Vidakovic¹

2020

VOJNOSANIT PREGL

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Background/Aim. Hand impairment in systemic sclerosis (SSc) patients is the most frequent manifestation of this progressive disease and often cause problems in daily activities and working ability. The correlation of altered hand functions in patients with SSc and their impact on working ability is not fully explained. The objective of this study is to assess the impact of altered hand functions of patients with SSc on their working ability. Methods. We assessed 20 patients with SSc (17 females, 3 males), with mean age of 45.5 ± 11.9 years (min 29, max 69, Med 44.0 years). The movements of fingers, wrist and forearm were examined by measuring active range of motion of the hand and fingers, muscle strength of the fingers, the skin lesions by modified Rodnan score, the function of the fingers, hands and forearms by the Hand Mobility in Scleroderma (HAMIS) test, as well as the condition of the capillaries in the fingers by capillaroscopy and working capacity by Work Ability Index (WAI). Results. Reduced strength on at least one tested muscle, was established in all patients, thickening of the skin on the hands in 14/20 (70%) and the fingers in 19/20 (95%), "scleroderma type" capillary changes in 15/17 (85%), decreased range of motion in finger joints in 16/20 (80%) of the patients. Also, 14/20 (70%) of subjects reported problems at work [decrease performance achieved in 8/20 (40%), reduction of working hours in also 8/20 (40%), leaving out some of the work in 14/20 (70%), and investing of extra effort in 15/20 (75%)]. By means of WAI, work ability assessment questionnaire, it was found that the working capacity was reduced in 11/20 (55%) of our patients. None of the patients was in the group of the most serious cases, the "poor" category; in the "moderate" category there were 6/20 (30%), while 5/20 (25%) of the patients were in the group with minimally reduced working capacity ("good" category). There was a statistically significant correlation between the thickened skin on the fingers (p < 0.05), reduced muscle strength in the fingers (p < 0.002) and limited mobility of the individual finger joints (p < 0.05), with information on reduced working capacity obtained by means of WAI questionnaire and with answers to questions about problems at work. Conclusion. The thickened skin on the fingers, reduced fingers muscle strength and limited mobility of certain finger joints in patients with SSc cause decreasing working capacity for all jobs that include manual activities.

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“…Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by skin and visceral fibrosis, widespread obliterative vasculopathy, and cellular and humoral immunity abnormalities (1,2). Vascular changes are initially subclinical, but later they become clinically-evident in the form of obliterative vasculopathy (3). SSc complications are common and may present as ischemic digital ulcers, scleroderma renal crisis, or pulmonary arterial hypertension (PAH) (2).…”

Section: Introductionmentioning

confidence: 99%

“…Nailfold capillaroscopy has emerged as a useful tool in the staging of the involvement of the micro-circulation in SSc patients. This test offers details about the disease severity, the degree of visceral involvement, and the appearance and progression of sclerodermic microangiopathy (3,4,5). Cutolo et al defined three patterns of microvascular involvement in SSc patients: early (few giant capillaries, few capillary micro-hemorrhages, no evident loss of capillaries, and a relatively well-preserved capillary distribution), active (frequent giant capillaries, frequent capillary micro-hemorrhages, moderate loss of capillaries, absence of or mildly ramified capillaries with slight disorganization of the capillary architecture), and late (irregular enlargement of the capillaries, almost absent giant capillaries and micro-hemorrhages, severe loss of capillaries with extensive avascular areas, ramified/bushy capillaries, and intense disorganization of the normal capillary array) (6,7).…”

Section: Introductionmentioning

confidence: 99%

N-terminal pro-brain natriuretic peptide in systemic sclerosis patients: correlation with nailfold capillaroscopy findings

Caraba¹,

Munteanu²,

Jianu³

et al. 2019

Ro J Rheumatol.

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Background. Pulmonary arterial hypertension (PAH) is an important cause of morbidity and mortality in patients with systemic sclerosis (SSc). This condition is diagnosed by cardiac Doppler ultrasonography, right-heart catheterization, or by serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP). The aim of this study was to assess the association between serum NT-proBNP and nailfold capillaroscopic patterns in SSc patients. We also analyzed the association between pulmonary function parameters, NT-proBNP, and nailfold capillary findings in patients diagnosed with SSc and PAH. Material and methods. We retrospectively analyzed SSc patients and healthy controls from our institution between July 2016-December 2018. We assessed by chart review: pulmonary artery systolic pressure (PASP), forced vital capacity (FVC), forced expiratory volume in 1 sec/forced vital capacity ratio (FEV1/FVC ratio), the number of nailfold capillaries/mm and NT-proBNP. Statistical analyses were performed using the Student's t-test, ANOVA test and the Pearson's correlation. Results. Seventeen patients with SSc and 17 healthy controls matched for age and gender were included. Among SSc patients, 13 had diffuse cutaneous SSc (dcSSc) and 4 patients had limited cutaneous SSc (lcSSc). PAH was identified in 10 SSc patients. In SSc patients, significant correlations have been identified between PASP and NT-proBNP (r=0.9, p<0.0001), nailfold capillaries density and PASP (r=-0.95, p<0.0001), and nailfold capillaries density and NT-proBNP (r=-0.84, p<0.0001). Conclusion. We suggest that in patients with SSc, NT-proBNP is significantly correlated with PASP and nailfold capillaroscopic findings.

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Nailfold capillaroscopy: relevance to the practice of rheumatology

Cited by 18 publications

References 47 publications

Nailfold capillary morphology in exfoliation syndrome

Nailfold capillary morphology in exfoliation syndrome

The impact of altered hands function on working ability of patients with systemic sclerosis

N-terminal pro-brain natriuretic peptide in systemic sclerosis patients: correlation with nailfold capillaroscopy findings

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